Sexual Health for Men

Confused about all of the erectile dysfunction meds being pitched to improve
your love life? Just want to know what you can do to be at your healthy, sexual
best this Valentine's Day? Urologist Peter Burrows, MD, joined us on Feb. 10 to
answer your questions about men's sexual health.

The opinions expressed herein are the guests' alone and have not been
reviewed by a WebMD physician. If you have questions about your health, you
should consult your personal physician. This event is meant for informational
purposes only.

MODERATOR: Welcome to WebMD Live, Dr. Burrows. We see so many ads for medications to treat erectile dysfunction (ED). Is ED on the rise or is it simply a matter of new medications coming to market?

BURROWS: I think it began with Pfizer when they introduced Viagra in 1998. They removed the stigma of erectile dysfunction or impotency. Before this, we never knew the incidence or the true amount of men who suffered from erectile dysfunction. So, with consumer-directed advertising and doctors' comfort levels about discussing erectile dysfunction, we learned how many men truly had this problem. Now there is no longer the stigma with discussing ED and there are three companies with effective medications; it seems that both physicians and patients are interested in learning and treating this condition.

"The choice of which medication to take depends on how the man and his partner typically engage in sexual activity."

BURROWS: They all work by inhibiting an enzyme called phosphodiesterase type V (PDE-V). This enzyme is found specifically in erectile tissue.

The three medications differ slightly on their side effect profile, their rate of action and their duration of action:

Viagra and Levitra are very similar in the rate of uptake, in that the majority of men will have the effect of the medication between 30 and 60 minutes and the medication is metabolized after 8 hours.

Cialis is slightly slower in uptake, approximately 60 minutes, but has a duration lasting 36 hours.

The choice of which medication to take depends on how the man and his partner typically engage in sexual activity. Some men prefer having a medication that works on demand and is out of their bodies within 8 hours. Some men enjoy the spontaneity allowed by a medication with a long half-life and they do not need to time when the medication is taken relative to sexual activity.

MEMBER QUESTION: I am a 60-year-old man who occasionally uses Viagra, but there are other times that I don't. Am I creating a dependence on the drug?

BURROWS: No. The medication works on demand and does not create immunity. That is, you will not need more of the medication as time goes on, even if you take it on daily basis.

BURROWS: The side effects of all three medications last only as long as the medication is in the bloodstream. There does not appear to be any long-lasting side effects once it has been metabolized.

MODERATOR: The warning to seek medical attention if erection lasts longer than 4 hours has been the subject of jokes, but it really isn't a laughing matter, is it?

BURROWS: This condition is known as priapism, and it is no joking matter. However, prolonged erection or priapism from this class of medications is exceedingly rare. To my recollection, there have only been a handful of patients worldwide to have had this condition and the majority of these patients have had other conditions or medications that can promote priapism.